Connie Mah Trinacty, PhD, is a health services researcher committed to a research career investigating strategies to address health disparities in care and outcomes for chronically ill patients. A K01 award will build upon a strong foundation of prior training and research, and provide necessary advanced education and experience through a multidisciplinary team of expert mentors and advisors and the outstanding resources of Harvard University. Valuable exploratory research experience will be gained in learning how organizational processes, actions, and structure in two large, differently structured health plans influence the adoption and sustainability of initiatives to address disparities (i.e., race/ethnicity, income, education) among their diabetes members. In recent years, health care disparities and quality improvement have become high priority research areas. In spite of increasing attention on addressing disparities, few empirical studies demonstrate sustainable success in reducing disparities in quality of care and outcomes for vulnerable diabetes populations. The influence of health systems in efforts to reduce disparities is not well understood, particularly in managed care organizations. The proposed research will identify and explore key health plan organizational factors (e.g., quality measurement process, product development and marketing strategies, participation in national disparities collaboratives) that may affect disparities; assess how well commonly used performance measures reflect underlying disparities in health care quality and outcomes among diabetes patients; and evaluate how providers' awareness and responsiveness to systems-based quality initiatives may impact differences in patient management. Through a mixed-methods approach to understand the complexity of health plan system structures and processes by which system-wide initiatives are implemented, this research program may shed light on why current efforts in eliminating existing disparities fail to realize their potential. In addition, this program will provide the foundation for Dr. Trinacty's transition to an independent investigator in the field of health disparities, with a focus on the linkages between systems, providers, and initiatives to reduce disparities for diabetes patients.